Epidemiological, clinical, pathological, and therapeutic aspects of gastric cancer in Morocco

Purpose: Gastric cancer is a relatively frequent cancer and has poor prognosis. The present study is the first Moroccan study to investigate the epidemiological, clinical, pathological, therapeutic characteristics, and outcomes of gastric cancer. Materials and Methods: We conducted a retrospective study including 154 cases of gastric cancer treated at the National Institute of Oncology between January 2007 and December 2007. Results: The mean age at diagnosis was 55 years (18-87 years) and the sex ratio was 2.14. Risk factors were dominated by tobacco use (30.5%) and gastric ulcer (4.5%). The average interval between symptom presentation and consultation was 8.7 months (1-48 months). The clinical symptoms were dominated by epigastric pain (88.7%), vomiting (62.3%), and weight loss (80.5%). Oeso-gastric fibroscopy was performed in all patients and showed an ulcerated aspect in 77.9% of the cases. The location of the tumor was antropyloric in 42.2% of the cases. The most common histology was adenocarcinoma (72.8%), followed by non-Hodgkin lymphoma (22%), gastrointestinal stromal tumors (GIST; 3.2%), and neuroendocrine tumors (NET; 2%). Tumor stage was metastatic in 62% of the cases, locally advanced in 18.5% of the cases, and localized in only 8% of the cases; however, 11.5% of patients were not staged. Also, 46% of the patients with adenocarcinoma (n = 111) were not treated, 6.4% received chemotherapy first (non-resectable) (one patient was operated), 20.6% received surgery first followed by adjuvant treatment, 4.5% received chemo-radiotherapy, 5.4% received chemotherapy only, and 27% received palliative chemotherapy. In the sub-group of patients diagnosed with non-Hodgkin lymphoma (n = 35), 48.5% received chemotherapy based on Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) regimen. In the sub-group diagnosed with GIST (n = 5) histology, all cases received surgery first and 2 cases received adjuvant chemotherapy based on doxorubicin. Finally, in the NET (n = 3) sub-group, 2 patients received surgery and 1 was not treated. The mean follow-up was 10 months for locally advanced tumors and 7.6 months for metastatic tumor. The overall survival rate at 3 years was not exceeding 20%. Conclusion: Clinical and pathological aspects of Moroccan patients are the same of those in developing countries. The majority of our patients were diagnosed at late stages, which explains the poor prognosis of gastric cancers in our population.